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Pre - Existing Disclosures

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21 Feb, 2021 by Manjunath Prasad

Hi Sir, Please help me with some clarity on the following -

1. I have seen many policies clearly define pre existing disease as the one which you got diagnosed/consulted/had symptoms, etc. only in the last 4 years. So, if I had a condition and got cured before 4 years, ideally I don't need to declare, right? So, don't you think, declaring something that was cured like long long back is not essential? If it even later becomes a dispute, don't you think IRDA will favor the Customer purely based on the definition of the pre-existing disease.

2. Don't you think overdoing in terms of disclosure may lead to rejection that will lead to more rejections given that you need to declare the previous policy rejections making the exercise counter productive. While its true that different companies are differently risk averse, I feel that as a business, they would rather find another customer for 5k premium instead of a risk of losing lakhs even if the risk is miniscule.

3. Recently PED definition got changed. IRDA guidelines say only those diseases which have been "consulted" in the last 4 yrs can be termed as Preexisiting. Is this amendment optional or is enforced. Please review how this amendment works out. 

4. An year back, I increased Sum insured for Super topup during Renewal with HDFC ERGO, an year after a minor surgery which was paid by Base policy of Religare. During Sum Insured increase procedure, they just sent a separate payment link with Insured amount. HDFC didn't ask for any disclosure. I even called the customer care if I have to disclose afresh of any recent developments. They said its not necessary, normal waiting period may apply for the increased insured amount. This is the general customer care department I talked to, not the underwriting/medical team. So, what may go wrong now? Should I inform them now ?

5. Its mentioned in the forum that the company will somehow find out about the diseases. Can you tell me how exactly, when there's no information trail whatsoever when the mention of any unrelated disease is not in any current reports unless the doctor tells you to mention. Its not like the medical history is linked to some PAN Card that they would have all the financial info in the CIBIL report, right? I am curious. Please shed some light. I see doctors take the customer side in reporting only what's absolutely necessary and that too only regarding the current condition as they feel the Insurance company will look for loopholes. 

6. Based on your experience, please name a few companies which accept policies for pre-existing disease more readily with/without premium loading.

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1 Answer

27 Feb, 2021
Gaur Nitai

Great question

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